Minimally invasive inguinal lymphadenectomy

The focus of this article is not purely on the technical aspects of a novel procedure, but also the considerations a team might pursue in adopting, modifying, or developing a new procedure of any type. Performing a minimally invasive inguinal lymphadenectomy is challenging even to individuals experience in laparoscopic techniques and with open lymphadenectomy. This article summarizes the approach to adopting any new technique and specifically addresses the learning curve for minimally invasive lymphadenectomy. In addition, specific technical aspects of the procedure are enumerated.     

小切口手术治疗小儿疝气的疗效观察

目的 观察小儿疝气应用小切口手术治疗的临床疗效。 方法 选取某医院2015年7月——2016年7月收治的38例采取传统手术治疗疝气的患儿为对照组,选取2016年8月至2017年8月收治的38例采取小切口手术治疗疝气的患儿为研究组,对手术相关指标、并发症发生率及患者护理前后生活质量评分等观察指标进行对比分析。 结果 研究组患儿术中出血量(3.2±0.7)mL,少于对照组的(8.1±1.3)mL;研究组切口(1.1±0.2)cm,小于对照组(2.7±0.5)cm;研究组平均住院时间(2.1±0.8)d,短于对照组的(3.6±0.2)d,差异均有统计学意义(P<0.05)。研究组患儿治疗总有效率97.37%,高于对照组的84.21%;研究组患儿并发症发生率5.26%,低于对照组的21.05%,差异有统计学意义(P<0.05)。生活质量评分比较,研究组、对照组患儿护理前比较,差异无统计学意义(P>0.05);研究组患儿护理后评分比对照组高,差异有统计学意义(P<0.05)。 结论 小儿疝气临床采取小切口手术治疗,切口小,出血量少,并发症低,平均住院时间短,利于患儿生活质量的提高,具有临床应用价值。     

髂腹下及髂腹股沟神经阻滞用于小儿腹

目的：探讨小儿腹股沟区手术麻醉安全便利的麻醉方法。方法：小儿腹股沟部手术40例．随机分成二组．1组20例以氯胺酮肌注后行髂腹下及髂腹股沟神经阻滞：Ⅱ组20例以氯胺酮胍注后行骶管阻滞麻醉。监测Bp、P．R．SpO2变化,及术毕清醒时间、术中不良反应。结果：平均年龄、手术时间两组无统计学意义（P〉0．05）．所有病例均较好地完成手术。两组生命体征．清醒时间无明显差异;切皮时Ⅱ组有4例出现肢体躁动;处理疝囊及牵拉精索时Ⅰ组中有4例出现肢体躁动;Ⅱ组有4例经多次穿刺成功．1例局部血舯。结论：作者认为髂腹下及髂腹股沟神经阻滞操作简单,穿刺引起的并发症及危险性少,麻醉效果与骶麻相似,可作为小儿腹股淘部手术的麻醉方法之一,特别是骶管阻滞困难时。     

Pre-surgical peripheral blood inflammation markers predict surgical site infection following mesh repair of groin hernia

Surgical site infection (SSI) is a costly postoperative complication with a decrease in the quality of life. We aimed to probe the predictive role of peripheral blood inflammation markers for SSI following mesh repair of groin hernia (GH).This retrospective study assessed the data of 1177 patients undergoing elective mesh repair of GH (open/laparoscopy) in the absence of antibiotic prophylaxis. The relation between demographics, surgical factors, pre-surgical laboratory results and the occurrence of SSI were investigated by univariate and multivariate analyses. Receiver operating characteristic analysis was performed to determine the optimal threshold of parameters and compare their veracity.The overall SSI rate was 3.2% with 1-year follow-up (38 superficial and 1 deep SSI). Patients with SSI had significant higher pre-surgical neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than those without (P = .029 and P = .045, respectively); their NLR and PLR correlated positively with postoperative total days of antibiotic treatment for SSI (r = .689, P = .000; r = .493, P = .001; respectively). NLR and PLR had larger areas under the receiver operating characteristics curves than neutrophil (.875 vs. .601; P = .000; .726 vs. .601; P = .017). The combination of PLR and neutrophil/NLR raised the predictive sensitivity of PLR for SSI (sensitivity: PLR: 74.36%; PLR + neutrophil: 82.05%; PLR + NLR: 83.57%). On multivariate analyses, higher preoperative NLR (cut-off 2.44) and PLR (cut-off 125.42) were independent predictors for SSI.Higher pre-surgical NLR and PLR may be valuable predictors for SSI following elective mesh repair of GH.     

Effectiveness and safety of single transseptal ablation for atrial fibrillation in real‐word practice

BackgroundWe have previously reported that unilateral groin‐single transseptal (ST) ablation in patients with paroxysmal atrial fibrillation (AF) was safe and significantly reduced patient discomfort compared with bilateral groin‐double transseptal (DT) ablation.HypothesisIn the present study, we hypothesized that ST ablation would be as effective and safe as DT ablation in real‐world practice like previous study. Among the 1765 consecutive patients in the Yonsei AF ablation cohort from October 2015 to January 2020, 1144 patients who underwent radiofrequency ablation were included for the analysis. Among them, 450 underwent ST ablation and 694 underwent DT ablation.ResultsThe total procedure time, ablation time, and fluoroscopy time were longer in the ST group than in the DT group (p < .05 for all). The hospital stay after catheter ablation was 1.3 ± 1.1 days which was longer in DT group than ST group (p = .001). No significant difference was observed in the complication rate (p = .263) and AF‐free survival rate (log‐rank p = .19) between the groups. However, after excluding patients who used antiarrhythmic drugs when AF recurred, the AF‐free survival rates were lower in the DT group than in the ST group before and after propensity score matching (log‐rank p = .026 and .047, respectively).ConclusionAlthough the ST approach increases the procedure time compared with the DT approach owing to the need for more frequent catheter exchanges, the ST approach is a feasible and safe strategy for AF ablation in terms of rhythm outcomes and risk of complications.